Brighton hospital trust is inadequate, says watchdog, and should be placed in special measures

The main NHS hospital trust for Brighton and Hove has been rated inadequate by the official watchdog which said that it should be placed in special measures.

The Care Quality Commission (CQC) also said that the trust’s main hospital, the Royal Sussex County Hospital, in Eastern Road, Kemp Town, was inadequate in a critical report published today (Wednesday 17 August).

Amid the criticisms, inspectors praised the Royal Alexandra Children’s Hospital, which is run by the same trust, Brighton and Sussex University Hospitals NHS Trust. The report described the Royal Alex as outstanding.

The CQC said: “England’s chief inspector of hospitals has recommended that Brighton and Sussex University Hospitals NHS Trust should be placed into special measures after an inspection by the Care Quality Commission rated the trust as Inadequate.

“A team of inspectors found the Royal Sussex County Hospital, Brighton, inadequate for safety and inadequate for leadership.

“Immediately after the inspection in April, CQC passed on its urgent concerns to the trust and NHS Improvement.

“CQC issued a warning notice to the trust requiring significant improvements by (Tuesday) 30 August in three areas

• The trust’s systems to assess, monitor and minimise risks to people receiving care and treatment as inpatients and outpatients were not operating effectively. Patients were being put at risk because they were not being dealt with properly or in appropriate areas.
• There were ineffective systems to ensure the care, privacy and dignity of people attending both hospitals as inpatients and outpatients.
• The trust had been failing to ensure patients were seen in line with national timescales for diagnosis and treatment. In many services, too many patients were on waiting lists which failed to meet national standards.

“CQC has today published a full report of the inspection which includes the ratings for individual services at each hospital http://www.cqc.org.uk/provider/RXH.

“Inspectors found that urgent and emergency services and medical care, critical care and outpatients at Royal Sussex County Hospital were inadequate for safety.

“Staffing levels and the skill mix in emergency departments, medical wards, critical care and midwifery were too low to ensure patients received the care they needed.

“Patients waiting in a corridor area of the emergency department were not assessed appropriately. There was a lack of clinical oversight of these patients and a lack of ownership by the trust board to resolve the issues.

“The main hospital buildings in Brighton were poorly managed, without consideration for patients’ dignity and safety.

“Parts of the hospital did not meet cleaning standards, the fabric of the buildings in some areas was poor and posed a fire risk.

“The old Barry and Jubilee buildings were overcrowded and cluttered with narrow corridors and inaccessible fire exits.

“At the time of the inspection, the trust was asked to take immediate action to address fire safety concerns.

“Some emergency patients were being accommodated in the operating theatres recovery area for up to three days – even though there were no appropriate patient toilets or facilities to allow access by relatives and carers.

“Patients’ privacy, dignity and confidentiality was compromised in the outpatients department, medical wards and emergency department, where inspectors found frail elderly patients without call bells, patients being examined without the use of privacy screens and medical history discussions in close proximity of other people.

“Staff from BME backgrounds and other groups with protected characteristics reported that bullying, harassment and discrimination were rife in the organisation.

“Staff complained that inconsistent application of human resource policies and advice contributed to inequality – but the board had been slow to address longstanding cultural issues within the trust.

“Inspectors rated the children’s services at the Royal Alexandra Children’s Hospital in Brighton as outstanding.”

The Royal Alexandra Children’s Hospital was rated outstanding by the CQC

Professor Edward Baker, the deputy chief inspector of hospitals, said: “It is clear that the problems we have found on this inspection go right through Brighton and Sussex University Hospitals NHS Trust.

“It is a matter of some concern that we found there was a distinct disconnect between the trust board and staff working in clinical areas, with very little insight by the board into the main safety and risk issues and seemingly little appetite to resolve them.

“For some time the trust has been failing to meet national standards on waiting and treatment times, there were high numbers of cancelled appointments and operations and delays in providing diagnostic results.

“We found that the executive team had failed on multiple occasions to provide resources or support to clinical staff in critical care and there was no acknowledgement that they understood the problems staff identified.

“The state and age of the buildings on the Royal Sussex County Hospital site presents a major challenge in the maintenance of standards of cleanliness and care.

“There are ambitious plans to redevelop the hospital. However, it is of little comfort to patients who need attention or treatment today to be told that the new building will eventually put things right.

“In the meantime staff and patients remain at risk from care and treatment being undertaken in an inappropriate environment.

Bullying and discrimination

“Following our inspection we issued the trust with a warning notice setting out that significant improvement was immediately required in a number of areas.

“The trust has acknowledged the work that needs to be done to address the issues and concerns our inspectors found.

“The trust has responded to that warning by producing a detailed programme of improvements as we required.

“Such is the level of our concern that we have no alternative but to recommend that the trust should be placed into special measures for the benefit of its patients.

“As a matter of priority the trust needs to address the longstanding issues surrounding its people policies and implement an immediate programme of change to improve the culture of the organisation.

“It must effectively address the allegations of bullying and discrimination that we have found.

“It is now the board’s duty to take charge of the issues we have identified and begin to provide the high-quality sustainable leadership that is required to deliver the necessary improvements.”

The CQC said that the inspection had identified a number of areas where the trust must improve including

• There must be sufficient numbers of staff with the right competencies, knowledge, qualifications, skills and experience to meet the needs of patients using the service at all times.
• The trust must ensure the 18-week referral to treatment time is addressed so patients are treated in a timely manner and their outcomes are improved. The trust must also monitor the turnaround time for biopsies for suspected cancer of all tumour sites.
• There must be clear procedures, followed in practice, monitored and reviewed to ensure that all areas where patients receive care and treatment are safe, well-maintained and suitable. In particular the risks of caring for patients in the Barry and Jubilee buildings should be closely monitored to ensure patient, staff and visitor safety.
• The trust must ensure that patients’ dignity, respect and confidentiality are maintained at all times in all areas and wards.
• The trust must undertake a review of the HR functions, including recruitment processes and grievance management.
• The trust must develop and implement a people strategy that leads to cultural change. This must address the current persistence of bullying and harassment, inequality of opportunity and the acceptance of poor behaviour.
• Fire plans and risk assessments must be reviewed to ensure that patients, staff and visitors to the hospital can be evacuated safely in the event of a fire.

The inspection also highlighted areas of outstanding practice, including

• The children’s emergency department was innovative and well led, ensuring that children were seen promptly and given effective care. Careful attention had been paid to the needs of children attending with significant efforts taken to reassure them and provide the best possible age appropriate care.
• The virtual fracture clinic had won an NHS award for innovation. It enabled patients with straightforward breaks in their bones to receive advice from a specialist physiotherapist by telephone. It reduced the number of hospital attendances and patients could start their treatment at home.
• Outstanding service was being delivered by dedicated staff on the stroke unit (Donald Hall and Solomon wards). The service was being delivered in a very challenging ward environment in the Barry building. Staff spoke with passion and enthusiasm about the service they delivered and were focused on improving the care for stroke patients.

The CQC inspection team consisted of a variety of specialists, including consultants in surgery, medicine, paediatrics and end of life care, senior nurses, a non-executive director, a director of nursing, allied health professionals and experts in facilities management, governance, pharmacy, and equality and diversity.

The team carried out its inspection in early April and returned for an unannounced visit as part of the same inspection on Sunday 13 April.

The CQC presented its findings to a local “Quality Summit”, including NHS commissioners, providers, regulators and other public bodies.

The purpose of the quality summit was to develop a plan of action and recommendations based on the inspection team’s findings.